Microcephaly is a condition in which a baby’s head and brain are smaller than normal for their age. It can be caused by malformations during pregnancy due to exposure to certain chemicals or infections from bacteria or viruses, such as the Zika virus.
Because the bones of the skull close too early, the brain cannot grow or develop properly, which can affect the child’s mental and physical development.
Depending on which parts of the brain are affected, a child with microcephaly may need lifelong care and ongoing medical support.
Common symptoms
The main symptoms of microcephaly include:
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Smaller head size than expected for age;
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Brain smaller than normal for the child’s age;
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Vision problems;
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Hearing loss;
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Developmental delay;
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Intellectual disability;
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Paralysis;
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Autism;
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Seizures and epilepsy.
Microcephaly can also lead to muscle stiffness because the brain’s ability to control movement is affected in children with this condition.
Confirming a diagnosis
Microcephaly can be diagnosed during pregnancy through prenatal exams such as ultrasound and confirmed after birth by measuring the baby’s head circumference, typically performed by a nurse or doctor.
Imaging tests such as a CT scan or MRI of the brain can help assess the severity of microcephaly and identify potential effects on the baby’s development.
Possible causes
The main causes of microcephaly include:
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Infection with the Zika virus or Chikungunya virus during pregnancy, especially in the first trimester;
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Maternal infections such as meningitis, HIV, rubella, cytomegalovirus, or toxoplasmosis;
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Use of cigarettes, alcohol, or drugs such as cocaine or heroin during pregnancy;
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Exposure to toxic substances such as mercury or copper;
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Malnutrition during pregnancy;
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Maternal metabolic conditions such as phenylketonuria;
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Radiation exposure during pregnancy;
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Use of certain medications in early pregnancy, such as those for epilepsy, hepatitis, or cancer.
Microcephaly can also have genetic causes and may occur in children with other syndromes, such as trisomy 13 (Patau syndrome), West syndrome, Rett syndrome, Down syndrome, or Edwards syndrome.
Children who have both microcephaly and one of these syndromes may present additional physical traits, disabilities, and complications compared to those who have only microcephaly.
Different types
Some studies classify microcephaly into different types:
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Primary microcephaly: Occurs when there are problems with the production of brain cells (neurons) during fetal development.
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Postnatal microcephaly: The baby is born with a normal head and brain size, but these do not grow at the same rate as the rest of the body.
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Familial microcephaly: The baby is born with a smaller head but shows no neurological abnormalities. This typically occurs when both parents also have smaller head sizes.
A less common category, called relative microcephaly, refers to children with neurological problems who also have reduced skull growth, though this term is rarely used by doctors.
Other studies differentiate between primary microcephaly, when the skull bones close too early during pregnancy (by the seventh month), and secondary microcephaly, when the closure occurs late in pregnancy or after birth.
Treatment options
Treatment for microcephaly should be managed by a pediatrician and a neurologist to help the child develop as well as possible and to improve quality of life.
1. Speech therapy
Speech therapy helps improve communication skills. The child should have regular sessions with a speech therapist, ideally three times per week.
Parents are encouraged to talk and sing to their child while maintaining eye contact and using gestures to help the child understand and stay engaged.
2. Physical therapy
Physical therapy helps improve motor development, balance, and muscle strength, and prevents atrophy and spasms. Sessions should be frequent (at least three times a week) and may include exercises with a Pilates ball, stretching, psychomotor activities, and hydrotherapy.
Physical therapy can benefit both physical and cognitive development.
3. Occupational therapy
For older children, occupational therapy can promote independence by teaching basic activities of daily life such as brushing teeth and eating, often with adaptive equipment.
Socialization is also important. Attending a regular school, when possible, helps children interact with peers and participate in activities that encourage emotional and social growth.
Children with significant developmental delays may not learn to read or write, but attending school can still help them connect with others. At home, parents should encourage active play, mirror games, and family interaction to keep the child’s brain stimulated.
4. Medications
Children with microcephaly may need medication prescribed by a doctor to manage symptoms. These may include:
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Anticonvulsants (such as diazepam) to control seizures;
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Stimulants (such as methylphenidate, brand name Ritalin) to manage hyperactivity;
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Pain relievers (such as acetaminophen) to reduce muscle pain caused by excessive tension.
5. Botox injections
In some cases, Botox injections may be recommended to help reduce muscle stiffness and improve reflexes, making physical therapy and daily tasks easier.
Botox is considered safe when administered in appropriate doses by a healthcare professional. It is usually prescribed when muscle contraction is so severe that it interferes with basic activities like bathing or diaper changes.
6. Head surgery
In certain cases, surgery may be performed to open the skull and allow the brain to grow, which can reduce the long-term effects of the condition.
However, this procedure is only effective if performed within the first two months of life and is recommended only when the potential benefits outweigh the risks.